Smoking Rate Can Be Slashed in Five Years

The smoking rate could be cut dramatically across the United States if political will is applied to do it. In California, the rate could be cut to ten percent in just five years, according to an analysis by UCSF researchers. Reducing smoking this quickly would save 50,000 lives in the state from heart attacks prevented during that period, says one of the study's authors.

Their study appears as a "Perspective" article in the Dec. 5 issue of MSJAMA, a section in the Journal of the American Medical Association (JAMA).

The U.S. Public Health Service has set a goal of reducing adult smoking prevalence to 15 percent by 2010, a goal that some find daunting since the current rate is between 23 and 26 percent, the authors state. But based on published data from the effects of large and aggressive tobacco control programs, this target is not only achievable in the state, but "surpassable," according to the study.

Using data from state and federal sources, the researchers estimated the average rate of decline in smoking consumption and prevalence for the first four states to create large tobacco control programs - California, Massachusetts, Arizona and Oregon. All these programs substantially accelerated the decline in smoking prevalence and per capita consumption above national rates, they note.

They show that a decline in California from 18 percent in 1999 down to 10 percent could be achieved if state and local governments restore the magnitude and aggressiveness of the California Tobacco Control Program to early 1990s levels. Similar results are possible in other states, they suggest. Achieving the ten percent goal might lead to a collapse of "public acceptability and social support networks for smoking," the authors note.

Effective programs would include aggressive anti-tobacco media campaigns that focus on exposing the tobacco industry's lies, the dangers of secondhand smoke and nicotine addiction, according to the researchers. Programs must also involve strong community-based efforts concentrating on clean indoor air laws and countering pro-tobacco influences in the community. Medically mediated smoking cessation programs, the authors note, are too expensive to achieve results on such a mass basis.

A re-invigorated tobacco control program could be financed with the billions of dollars available to the states from the 1998 Master Settlement Agreement that ended state litigation against the tobacco industry, the authors suggest.

"We know how to rapidly reduce smoking and immediately save lives, particularly by reducing heart attacks, which respond to smoking cessation very quickly," said Stanton Glantz, UCSF professor of medicine and senior author of the paper. "But politicians around the country are using the current budget difficulties as an excuse to gut these effective programs."

Health advocates are fighting major cuts in tobacco control programs in Florida, Ohio, Hawaii, Arizona, and elsewhere according to Glantz, and they are waiting to see whether California Governor Davis acts to reinvigorate California's program or cut it.

"It makes no sense to cut tobacco control programs even in tight fiscal times because they save the state more money in medical expenses than they cost - from immediate benefits in terms of fewer heart attacks and fewer low birth-weight infants," Glantz added.

Lead author is Asaf Bitton, a UCSF medical student. Caroline Fichtenberg, a former UCSF researcher, now a PhD student at Johns Hopkins University, collaborated in the study and co-authored the paper.